On Tuesday a plaintiff who was the recipient of insurance coverage under an ERISA-based employer plan filed a case in the Utah District Court against Dignity Health and Blue Cross Blue Shield of Utah, the third party administrator for the plan. The complaint alleged that BCBS wrongfully denied benefits claims for residential mental health treatment.
The Mental Health Parity and Addiction Equity Act, according to the filing, requires health plans that offer mental health benefits to offer those benefits in “parity” or equivalent levels of coverage and with equivalent decision making processes to those offered for medical coverage. This includes payment for mental health treatment at inpatient levels of coverage. An insurance company cannot institute additional or disparate standards for the mental health treatment that are not also applied to medical treatments.
The patient in this case, a child of the plaintiff, received inpatient mental health treatment from the Open Sky Wilderness Therapy Center for mental health and substance abuse issues. The defendants, after granting an initial favorable determination of benefits, denied coverage for the treatment, stating that the Open Sky Wilderness Therapy Center was not licensed as a general acute care hospital according to state and local laws or registered as a general hospital by the American Hospital Association.
The plaintiff disputed this denial, indicating that the center was accredited by the State of Colorado. However, BCBS specifically disputed the lack of additional accreditation as a full service acute care hospital and specifically denied coverage for wilderness based treatment.The plaintiff alleged that BCBS failed to comply with the standards of ERISA and the Mental Health Parity act and seeks payment of the treatment with interest, attorney fees, and injunctive relief.
The plaintiff is represented by G. Eric Nielson & Associates.